Incontinence among young women with Crohnʼs disease - impact on the choice of delivery mode?

Abstract

Crohn's disease (CD) might be of importance for rectal compliance as well as faecal consistency with secondary impact on faecal continence. Most women with CD undergo delivery with risk for sphincter injuries resulting in further impact on continence. This study was a pilot study aiming at investigating continence among women with CD and the importance of a previous vaginal delivery. All 85 women with CD between 20 to 40 years of age treated at the University Hospital were identified. They were sent a well established questionnaire regarding faecal continence. Replies were returned by 56 (65.9%). Twenty-six (46.4%), age 35 (28-40) had had at least one vaginal delivery. Thirty (53.6%), had had no delivery or had undergone a caesarian section (n =5). Comparison was made to 277 women between the ages 31-45 years without CD derived from the background population. Among women with CD 19.6% seldom or never were able to let go of wind without concomitant faecal leakage; corresponding figures for controls were 3.3% (p<0.0001). 32.1% were unable to defer bowel emptying for more than 15 minutes whereas the corresponding figure for controls was 18.7% (p<0.05). Women with CD had leakage of solid stools more than once a week in 3.6% of cases, for loose stools in 19.6% and for gas in 28.6%. Corresponding figures for controls were 0% (p<0.05), 0.4% (p<0.0001) and 8.1% (p<0.0001). Soiling occurred in 30.4% and 2.6% respectively (p<0.0001). Women with CD divided into those with a prior vaginal delivery and those with no delivery or a caesarian section did not differ significantly regarding these above mentioned data. Women with CD in a child-bearing age have in comparison to a contolgroup of women in a corresponding age-group marked symptoms of incontinence. A previous vaginal delivery had in this limited material no further negative impact on continence. With increasing age, however, these women might be at risk for pronounced faecal incontinence.